Kawasaki Disease

Kawasaki’s Disease (KD) is a condition that is often thought of while “pimping” students, but in clinical practice it is often quickly disregarded. Unfortunately, KD is the leading cause of acquired heart disease in children in the developed world (surpassing Rheumatic Fever) and deserves more attention.

The diagnosis is a clinical one… but a difficult one to make [3].

It truly requires you to play the role of a medical sleuth as there is no single pathognomonic feature.

There are many other entities that appear like KD and it is commonly confused with:

Scarlet Fever

Lymphadenitis

Viral Infections (Adenovirus, Enterovirus, EBV, Measles)

Juvenile Rheumatoid Arthritis, Toxic Synovitis, Septic Arthritis

Stephens Johnson Syndrome, Staph Scalded Skin, Toxic Shock Syndrome

Drug Hypersensitivity

When entertaining any one of these other entities, make sure you consider KD also.

Unfortunately, there are no lab values that are diagnostic; however, they can strengthen your clinical suspicion.

CRP and ESR are usually elevated. Thrombocytosis is also common after 1 week of illness.

33% will have sterile pyuria (be careful what you call a UTI)

Mildly-Moderately elevated LFTs (it is a systemic vasculitis)

50% of those who have an LP will have a CSF pleocytosis (does that irritable kid have meningitis or KD?)

More unfortunate is the fact that the coronary artery complications can occur even when the full criteria for KD are not met – Incomplete Kawasaki Disease(not Atypical).

Consider Incomplete KD in any child with prolonged fever PLUS 2 or 3 of the characteristic features.

If entertaining the diagnosis, obtain ESR/CRP. If Abnormal proceed with the evaluation which will include a cardiac Echo to evaluate the coronary arteries (See Newburger for a nice guideline).

Keep a lower threshold for obtaining an Echo in children who are 6 months of age or less (higher likelihood for developing coronary artery aneurysms), fever > 6 days, evidence of systemic inflammation, or no other explanation for the fever.

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I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

[…] may be very few “rash emergencies,” there are several significant conditions to ponder (ex, Kawasaki, ITP, HUS) as well as less concerning ones (ex, Molluscum). Additionally, before you dismiss the […]